How does this medication work? What will it do for me?

This medication contains two active ingredients that are used to treat asthma and chronic obstructive pulmonary disease (COPD). The two active ingredients are salmeterol and fluticasone. Salmeterol belongs to a group of medications called bronchodilators. These medications relax the muscles in the walls of the small air passages in the lung, keeping the air passage open and making it easier to breathe. Fluticasone belongs to a group of medications known as corticosteroids. Corticosteroids reduce inflammation in the lungs and help reduce the swelling and irritation in the walls of the small air passages in the lungs. This helps open the airways and improve breathing.

The inhaled powder for the Diskus can be utilized to treat asthma and COPD, whereas the inhaled aerosol can be utilized to treat asthma.

It is important to remember that salmeterol - fluticasone is intended for long-term relief and is not intended for immediate relief. Inhalers that contain "reliever" medications with fast action (e.g., salbutamol, terbutaline) will still be needed while using this medication.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
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What form(s) does this medication come in?

Advair 125
A pressurized metered-dose inhaler (MDI) consisting of an aluminum canister with a metering valve. Each canister is fitted into the supplied purple actuator/adaptor. A dust cap is fitted over the actuator's mouthpiece when not in use. It delivers 25 µg salmeterol (as the xinafoate salt) and 125 µg fluticasone propionate per actuation. Nonmedicinal ingredient: HFA-134a (1,1,1,2-tetrafluoroethane). It contains no excipients. Formats of 120 doses.

Advair 250
A pressurized metered-dose inhaler (MDI) consisting of an aluminum canister with a metering valve. Each canister is fitted into the supplied purple actuator/adaptor. A dust cap is fitted over the actuator's mouthpiece when not in use. It delivers 25 µg salmeterol (as the xinafoate salt) and 250 µg fluticasone propionate per actuation. Nonmedicinal ingredient: HFA-134a (1,1,1,2-tetrafluoroethane). It contains no excipients. Formats of 120 doses.

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How should I use this medication?

The usual recommended dose for adults and children 12 years of age and older is two inhalations of the appropriate strength (as decided by your doctor) twice daily.

Gargle with water after each use to prevent hoarseness and thrush of the mouth and throat.

Read the package insert or speak with your pharmacist for instructions on how to use the inhaler properly. If you have difficulties there are products that can be used with the inhaler to improve how well it works.

To make sure the medication remains effective, it is very important to use it regularly twice a day, exactly as prescribed by your doctor, even when you are not experiencing symptoms of asthma. To prevent side effects, do not use this medication more often than prescribed.

Many things can affect the dose of medication that a person needs, such as the severity of the condition, body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

If you miss a dose of this medication, use it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature with the cover on tight, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use this medication if you:

  • are allergic to salmeterol, fluticasone, or any ingredients of the medication, including lactose or milk
  • have abnormal heart rhythms known as tachyarrhythmias
  • have moderate to severe bronchiectasis or status asthmaticus
  • have untreated fungal, bacterial, or tuberculous infections of the lungs
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What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • body aches or pains
  • congestion
  • cough
  • dizziness
  • fast heartbeat
  • fatigue
  • headache
  • hoarseness
  • mouth, tongue, or throat irritation
  • muscle cramps or pain
  • nausea
  • tremor
  • vomiting

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • sores, ulcer, or white patches in the mouth or throat

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • difficulty swallowing, breathing, or speaking
  • skin rash or hives all over the body
  • sudden wheeziness and chest pain or tightness
  • swelling of face, lips, tongue, throat, or eyelids
  • worsening asthma symptoms even after using your reliever medication

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

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Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Asthma attacks: This medication is not a "reliever" medication. If you start developing asthma symptoms, be sure to use your "reliever" medication for rapid relief of your asthma symptoms. It is very important that you have your "reliever" medication with you at all times. If you persistently use more of your "reliever" medication, contact your doctor.

Eye problems: If you are at risk of developing glaucoma or cataracts, have your eyes checked by your doctor before starting long-term treatment with this medication. You should have your eyes monitored at regular intervals while using this medication.

Infections: Fluticasone may cause thrush infection in the mouth and throat. To reduce the risk of infection, gargle with water after each use of this medication.

Medical conditions: If you have high blood pressure, heart problems, diabetes, thyroid problems, or epilepsy (seizures), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Steroid medication use: If you have taken or are still taking oral steroid medications over the last several months, consult with your doctor before using this medication. In times of stress or during a severe asthma attack, your doctor may want you to start your oral steroid medication again.

Stopping medication: Do not stop this medication abruptly, as this may cause your condition to get worse. When this medication is stopped, it should be stopped gradually as directed by your doctor.

Worsening symptoms: If you find you need to use your short-acting ("rescue") inhaler more often or if your condition seems to worsen, call your doctor. If you have not been given instructions beforehand, contact your doctor immediately about what to do if any of the following situations occur (they may be signs of seriously worsening asthma):

  • decreased effectiveness of short-acting, inhaled bronchodilators such as salbutamol, terbutaline, or fenoterol (less than 4 hours of relief)
  • need for more inhalations than usual of short-acting, inhaled bronchodilators
  • peak flow meter showing results in the below-normal range

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking salmeterol - fluticasone, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of the diskus form of this medication have not been established for children under 4 years of age. The safety and effectiveness of the inhaler form of this medication have not been established for children under 12 years of age.

What other drugs could interact with this medication?

There may be an interaction between salmeterol - fluticasone and any of the following:

  • ASA (acetylsalicylic acid)
  • atomoxetine
  • beta-blocker medications (e.g., propranolol, metoprolol, atenolol, labetalol)
  • digoxin
  • diuretics (e.g., hydrochlorothiazide, furosemide)
  • ketoconazole
  • medications that cause low potassium (e.g., hydrochlorothiazide, furosemide, high doses of prednisone)
  • monoamine oxidase (MAO) inhibitors (e.g. phenelzine, tranylcypromine)
  • ritonavir
  • sympathomimetic medications (e.g., caffeine, ephedrine, pseudoephedrine)
  • tricylic antidepressants (e.g. amitriptyline, desipramine)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.